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SOURCE

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Source: Law RM, Law DTS. Dermatologic drug reactions and common skin conditions. In: DiPiro JT, Talbert RL, Yee GC, Matzke GR, Wells BG, Posey LM, eds. Pharmacotherapy: A Pathophysiologic Approach. 10th ed. New York, NY: McGraw-Hill; 2017. http://accesspharmacy.mhmedical.com/content.aspx?bookid=1861&sectionid=146079670. Accessed May 10, 2017.

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CONDITION/DISORDER SYNONYM

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  • Diaper rash.

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DEFINITION

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  • Acute, inflammatory contact dermatitis of buttocks, genitalia, perineal regions, lower abdomen, or thigh folds of infant or toddler resulting from direct fecal and moisture contact with skin in occlusive environment.

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CLINICAL PRESENTATION

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SIGNS AND SYMPTOMS
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  • Erythematous rash; vesicles and oozing erosions may be present in severe cases.

  • May be infected by Candida species and present with confluent red plaques, papules, and pustules.

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DIAGNOSIS

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  • Based on clinical presentation.

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DESIRED OUTCOMES

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  • Relieve symptoms.

  • Remove precipitating factors.

  • Prevent recurrences.

  • Avoid adverse treatment effects.

  • Improve quality of life.

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TREATMENT: NONPHARMACOLOGIC THERAPY

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  • Frequent diaper changes.

  • Air drying (remove diaper for as long as practical)

  • Gentle cleansing with nonsoap cleansers and lukewarm water.

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TREATMENT: PHARMACOLOGIC THERAPY

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  • May apply zinc oxide for astringent and absorbent properties and to provide effective moisture barrier.

  • Apply topical imidazole antifungal agents for Candida (yeast). Discontinue therapy when rash subsides and continue barrier product to prevent recurrence.

  • May use very low potency topical corticosteroid (hydrocortisone 0.5–1%) for short periods (1–2 weeks) in severe inflammatory cases.

  • Commercial diaper wipes containing fragrance or alcohol should be avoided.

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MONITORING

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  • Educate caregivers on causative factors, preventive measures, and useful treatments.

  • Evaluate patients periodically to assess efficacy of therapy and possible side effects.

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Date Written: May 10, 2017

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Contributor: Lauren Roller, PharmD, BCCCP

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Editor: Lauren Roller, PharmD, BCCCP; Laura Baumgartner, PharmD, BCPS, BCCCP

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